HEAL Preventing Opioid Use Disorder: a Vision for Research to Increase Access to Prevention Services

Launched in 2018, the National Institutes of Health (NIH) Helping to End Addiction Long-term Initiative®, or NIH HEAL Initiative, is an aggressive effort to speed scientific solutions to stem this national public health crisis. Investments in new strategies to prevent opioid misuse are a key component of this comprehensive response to the opioid epidemic. In 2019, funded through the NIH HEAL Initiative® and administered by the National Institute on Drug Abuse (NIDA), HEAL Preventing Opioid Use Disorder (HEAL Preventing OUD) research program began, filling the gap of needed upstream prevention interventions. The vision for HEAL Preventing OUD is that: Healthcare organizations and public systems will be able to make evidence-based preventive intervention services accessible to all persons who experience risk for opioid and other substance misuse or use disorder. Realizing this vision will require research investments in four strategic areas: (1) risk identification; (2) intervention development; (3) social determinants, health equity, and policy; and (4) dissemination, implementation, scale up, and sustainment. There exists tremendous potential for prevention to be a viable solution for the ongoing opioid crisis, particularly through investments in upstream, equitable, and sustainable prevention services.

Introduction to Helping to End Addiction Long-Term Prevention Cooperative: Overview and Strategies

This supplemental issue describes the individual studies and collaborative efforts of the Helping to End Addiction Long-term Prevention Cooperative's (HPC's) innovative approaches to rapidly develop evidence-based prevention programs for widespread dissemination. This introduction succinctly reviews (1) the context that demands the rapid development of efficacious prevention programs and their scale-ups, (2) the unique objectives of the individual HPC research projects, and (3) collective efforts to harmonize research across studies to advance the prevention of opioid misuse and gain insight into opioid misuse etiology to inform improvements in preventive interventions. At the conclusion of HPC studies, we anticipate the availability of multiple evidence-based programs to prevent opioid misuse and use disorder for persons who experience particular sources of risk and for delivery in settings where prevention has traditionally been lacking. By harmonizing and coordinating efforts across 10 distinct outcomes studies of prevention programs and making data available for analysis by non-HPC researchers, the HPC's efficacy and etiology evidence will far surpass the additive contributions of 10 individual research projects.

Including Community Partners in the Development and Adaptation of Intervention Strategies to Prevent Initiation or Escalation of Opioid Misuse

Current literature lacks clear examples of how to engage with communities in the development of opioid misuse interventions for diverse populations and across various settings. The National Institutes of Health (NIH) Helping to End Addiction Long-term® Initiative (HEAL) Prevention Cooperative (HPC) research projects work collaboratively with communities to develop and adapt their opioid misuse interventions to increase both feasibility and sustainability. Ten HPC projects were selected to receive NIH funding and are required to have partnerships with communities where their intervention is being conducted. This paper applies the Centers for Disease Control and Prevention (CDC)-adapted Public Participation Framework to examine the levels of community engagement used by each of these 10 HPC projects (Clinical and Translational Science Awards Consortium Community Engagement Key Function Committee Task Force on the Principles of Community Engagement, 2015). Using this framework, this paper illustrates the range of community engagement approaches and levels that the HPC projects rely on to develop, adapt, and adopt opioid prevention interventions across diverse populations and settings. This paper also lays a foundation for future examinations of the role of community engagement in intervention implementation and effectiveness and the level of community engagement that is necessary to improve intervention effectiveness.

The cascading development of autonomy and relatedness from adolescence to adulthood

A developmental cascade model of autonomy and relatedness in the progression from parent to friend to romantic relationships across ages 13, 18, and 21 was examined among 184 adolescents (53% female, 58% Caucasian, 29% African American) recruited from a public middle school in Virginia. Parental psychological control at age 13 undermined the development of autonomy and relatedness, predicting relative decreases in autonomy and relatedness with friends between ages 13 and 18 and lower levels of autonomy and relatedness with partners at age 18. These cascade effects extended into adult friendships and romantic relationships, with autonomy and relatedness with romantic partners at age 18 being a strong predictor of autonomy and relatedness with both friends and partners at age 21.

Older opposite-sex romantic partners, sexual risk, and victimization in adolescence

This study examined how age gaps among opposite-sex romantic partners related to sexual risk-taking and victimization by partners among 201 at-risk adolescents (60.2% female). We examined three questions: (a) is younger partner age, age gap between partners, or a combination of these two factors most strongly related to negative outcomes; (b) do age gaps relate to negative outcomes differently for male versus female adolescents; and (c) why do age gaps relate to negative outcomes? Results revealed that the wider the age gap between partners, the more likely adolescents were to engage in sex and the less likely they were to use protection against pregnancy and STIs. Wider age gaps were also associated with more frequent emotional and physical victimization and higher odds of unwanted sexual behavior. Findings did not differ significantly by gender or younger partner age. Analyses revealed that the wider the age gap, the more likely both partners were to engage in risky lifestyles (i.e., substance use and delinquency), and risky lifestyles - rather than poor negotiation or decision-making equality - helped to explain associations between age gaps and engagement in sexual intercourse and victimization experiences. Results suggest that relationships with age gaps tend to involve two partners who are engaging in deviant lifestyles overall, further corroborating the need to identify and provide services to these youth. Results also support movements toward considering partner age gaps rather than relying on a set age of consent when determining adolescents' legal competency to consent to sex.

Maternal and Paternal Psychological Control as Moderators of the Link between Peer Attitudes and Adolescents' Risky Sexual Behavior

Maternal and paternal psychological control, peer attitudes, and the interaction of psychological control and peer attitudes at age 13 were examined as predictors of risky sexual behavior before age 16 in a community sample of 181 youth followed from age 13 to 16. Maternal psychological control moderated the link between peer attitudes and sexual behavior. Peer acceptance of early sex predicted greater risky sexual behaviors, but only for teens whose mothers engaged in high levels of psychological control. Paternal psychological control demonstrated the same moderating effect for girls; for boys, however, high levels of paternal control predicted risky sex regardless of peer attitudes. Results are consistent with the theory that peer influences do not replace parental influences with regard to adolescent sexual behavior; rather, parental practices continue to serve an important role either directly forecasting sexual behavior or moderating the link between peer attitudes and sexual behavior.

Inter-Parent Aggression as a Precursor to Disengagement Coping in Emerging Adulthood: The Buffering Role of Friendship Competence

Using multi-informant data drawn from a prospective study involving 184 youth, mother perpetrated and father perpetrated partner aggression during early adolescence (age 13) was examined as a predictor of five types of disengagement coping strategies in emerging adulthood (age 21): behavioral disengagement, mental disengagement, denial, substance use, and restraint. The ability to develop close friendships, or friendship competence, was examined as a moderator of these links. Results suggest that inter-parent aggression in early adolescence can predict reliance on disengagement coping eight years later, but that friendship competence can buffer against the reliance on disengagement coping. Moreover, close friendship competence was not directly related to partner aggression by mothers or fathers, suggesting that friendship competence develops along an independent developmental track, and thus may truly serve as a buffer for young adults with a history of exposure to inter-parent aggression.

Is it love or sexual abuse? Young adults' perceptions of statutory rape

Adults under age 25 comprise the majority of statutory rape perpetrators, yet we know little about their perceptions of statutory relationships. We assessed 210 (50% male) young adults' perceptions of statutory rape involving a 15-year-old female adolescent and a male who was either 2, 4, or 6 years older. Across all age gaps, 73.7% of participants felt the relationship should not be a crime. Participants who read about a 4- or 6-year (versus 2-year) age gap perceived the relationship as significantly more of a crime and the older partner as more responsible and in need of legal intervention. Effects were partially mediated by perceptions of the relationship as exploitive. Results suggest a need to educate young adults about statutory rape.

A comparison of diversity, frequency, and severity self-reported offending scores among female offending youth

[Correction Notice: An Erratum for this article was reported in Vol 24(3) of Psychological Assessment (see record 2012-04601-001). The article contained a number of errors which are corrected in the erratum.] Despite general consensus over the value of measuring self-reported offending, discrepancies exist in methods of scoring self-reported offending and the length of the reference period over which offending is assessed. This analysis compared the concurrent interassociations and longitudinal predictive strength of diversity, frequency, and severity offending scores measured over the past 6 months and diversity and severity scores measured "ever" between assessments. For violent offending, different scorings were highly correlated and equally predictive of adulthood offending. For nonviolent offending, there was significant continuity in diversity and severity-weighted diversity scores over the transition to adulthood but not in nonviolent frequency or severity-weighted frequency scores. Results support the use of offending diversity scores rather than offending frequency scores and highlight the importance of examining nonviolent and violent offending as separate constructs.

Gender differences in jurors' perceptions of infanticide involving disabled and non-disabled infant victims

OBJECTIVES

The present study investigated the influence of juror gender and infant victim disability on jurors' reactions to infanticide cases.

METHODS

Participants (men and women undergraduates) read a summary of a mock trial involving alleged father-perpetrated infanticide. The infant was described as severely mentally disabled or as not disabled. Participants completed a series of case-related judgments (e.g., guilt; sentence; and empathy, sympathy, and similarity toward the defendant and victim).

RESULTS

There were pervasive gender differences such that compared to men, women mock jurors rendered more guilty verdicts, perceived the father/defendant as having greater intent to kill his infant, and felt less similar to the defendant. Compared to men, women also believed the father was more responsible and the pneumonia was less responsible for the infant's death, had less sympathy and empathy for the defendant, endorsed more negative beliefs about the father, and were more likely to believe the infant was a unique person. Mediational analyses revealed that these statistically significant effects were explained, in part, by gender differences in attitudes toward the defendant. Further, whether the infant victim was portrayed as severely disabled (versus developmentally normal) had little effect on central case judgments such as verdict, but jurors who believed the infant was severely disabled gave significantly shorter sentences to the defendant, were less likely to perceive the defendant as mentally ill, and felt significantly less empathy for and similarity to the infant victim.

CONCLUSIONS

Although juror gender consistently predicted juror's judgments, there were fewer effects of disability status. Even so, bias against disabled infants manifested for several dependant variables.

PRACTICAL IMPLICATIONS

This research can inform legal professionals about the potential for bias in juror decision-making, and in turn, help facilitate fairness and justice for the youngest and most vulnerable victims of child abuse.